Wang Michael C, Awoyemi Toluwalase, Allen Norrina B, Shah Ravi, Nayor Matthew, Luo Yuan, Lima Joao A C, Lloyd-Jones Donald M, Khan Sadiya S
Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
Am J Prev Cardiol. 2024 Nov 15;20:100889. doi: 10.1016/j.ajpc.2024.100889. eCollection 2024 Dec.
To generate data-driven phenogroups of cardiac structure and function based on echocardiographic measures assessed in asymptomatic middle-aged adults free of CVD, and examine associations between these newly defined phenogroups and incident premature cardiovascular disease (CVD).
Data were analyzed from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study free of CVD who underwent an echocardiogram at the Year 25 (2010-2011) in-person examination. Continuous echocardiographic measures of left heart structure, left ventricular systolic function (including strain) and diastolic function, right ventricular systolic function, and hemodynamic measures were included in latent class analysis to generate novel phenogroups. Associations between data-driven phenogroups and risk of premature CVD (coronary artery disease, stroke, or heart failure) were estimated using Cox proportional hazards regression adjusted for traditional CVD risk factors.
Among 3361 participants, mean (standard deviation) age was 50.1 (3.6) years, 57% were female, and 46% were non-Hispanic Black. Three overall phenogroups were identified and labeled as: (1) optimal cardiac mechanics (36.2%); (2) suboptimal systolic function (38.2%); and (3) suboptimal diastolic function (25.6%). Over a median 8.9 years of follow-up, 121 premature CVD events occurred. Risk of CVD was higher in the suboptimal diastolic function group (unadjusted hazard ratio [HR] 4.08 [95% CI: 2.48, 6.71] and adjusted HR 1.95 [1.12, 3.40]) compared with the optimal group. The suboptimal systolic function group had a higher unadjusted risk of CVD (1.86 [1.10, 3.15]), which was attenuated after adjustment for CVD risk factors (1.36 [0.79, 2.36]).
Unbiased, data-driven clustering of echocardiographic measures in middle-aged adults identified distinct patterns of cardiac remodeling that were associated with risk of premature CVD. Premature CVD risk was highest with the pattern of suboptimal diastolic function. This suggests potential utility of a composite echocardiography-based index for prioritizing prevention strategies earlier in the life course.
基于对无症状中年无心血管疾病（CVD）成年人进行的超声心动图测量，生成由数据驱动的心脏结构和功能表型组，并研究这些新定义的表型组与早发性心血管疾病（CVD）之间的关联。
对年轻成年人冠状动脉风险发展（CARDIA）队列研究中无CVD且在第25年（2010 - 2011年）现场检查时接受超声心动图检查的参与者的数据进行分析。左心结构、左心室收缩功能（包括应变）和舒张功能、右心室收缩功能以及血流动力学测量的连续超声心动图指标被纳入潜在类别分析，以生成新的表型组。使用针对传统CVD风险因素进行调整的Cox比例风险回归估计数据驱动的表型组与早发性CVD（冠状动脉疾病、中风或心力衰竭）风险之间的关联。
在3361名参与者中，平均（标准差）年龄为50.1（3.6）岁，57%为女性，46%为非西班牙裔黑人。确定了三个总体表型组并标记为：（1）最佳心脏力学（36.2%）；（2）次优收缩功能（38.2%）；（3）次优舒张功能（25.6%）。在中位8.9年的随访期间，发生了121例早发性CVD事件。与最佳组相比，次优舒张功能组的CVD风险更高（未调整风险比[HR] 4.08 [95% CI：2.48, 6.71]，调整后HR 1.95 [1.12, 3.40]）。次优收缩功能组的CVD未调整风险更高（1.86 [1.10, 3.15]），在调整CVD风险因素后风险降低（1.36 [0.79, 2.36]）。
对中年成年人的超声心动图测量进行无偏倚、数据驱动的聚类，识别出与早发性CVD风险相关的不同心脏重塑模式。次优舒张功能模式下早发性CVD风险最高。这表明基于超声心动图的综合指标在生命历程中更早地确定预防策略方面具有潜在效用。
